• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

CPT Code 96372

T

TYSON1234

Guest
Messages
160
Location
Montrose, MI
Is anybody else having problems billing 96372????? This has always been a payable code, but now Cigna and HAP are denying this code. Any input would be appreciated.

Thank you!!!
 
No, their denials state this procedure code is disallowed because the related primary service wasn't billed or denied. I called both insurance companies and they told me to bill a 99211/99212 with the code. I told them "NO", because they're only coming in for injection only.
 
I have always billed the injection fee only. I looked on their websites to see if they had something posted and couldn't find anything. I guess I can try to add the injection on the claim with $0.01 and see what happens.
 
Why aren't you billing for the cost of the drug with a j-code? Or is it patient provided? If it's patient provided, then bill it with $0.01 as stated above!
 
Pt brought her own medicine, we do not provide it for the patient. The denial code was " This procedure code is disallowed because the related primary service wasn't billed or denied."
 
TYSON1234 said:
Is anybody else having problems billing 96372????? This has always been a payable code, but now Cigna and HAP are denying this code. Any input would be appreciated.

Thank you!!!
Click to expand...

In the CPT book "Do not report 96372 for injections given without direct physician or other qualified health care professional supervision. To report, use 99211. Hospitals may report 96372 when the physician or other qualified health care professional is not present"

Im reading this and what Im understanding if Im not mistaken is that is only hospitals may use 96372. But for office setting only 99211 can be used, because 96372 is bundled with 99211. I also looked into the CCI edits and it shows (0) on 99211, Indicates that there are no circumstances in which a modifier would be appropriate.

But i would also like clarification why it is being bundled...
 
You can use 96372 in the office setting, you just must have a physician or NP in the office at the time of the service, you cannot use a 99211 when the reason for the encounter is to give an injection.
 
Question along the same lines with the injection. We're debating if an antibiotic injection can be charged when given as a precaution against infection prior to a planned procedure done in the office. I was taught that when done as a prophylactic with a procedure that it is bundled, but now can't find anything in writing to support this. I know Blue Cross has rejected the ones the office tried to bill out as bundled with the procedure, but is this the hard and fast rule across the board?
 
You must log in or register to reply here.
Top